Provider Demographics
NPI:1891571584
Name:HAGEL, MADISYN
Entity Type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:HAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5964
Mailing Address - Country:US
Mailing Address - Phone:316-618-1252
Mailing Address - Fax:316-869-2277
Practice Address - Street 1:423 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-618-1252
Practice Address - Fax:316-869-2277
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01949224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant